Tumor inguinal asociado a reemplazo total de cadera

Abstract

Organized hip hematoma is an infrequent pathology, but it can be associated with multiple factors such as anticoagulation and trauma. It is important to make an early diagnosis to alleviate symptoms and rule out complex tumor lesions or those with a high degree of malignancy. In addition to the anamnesis, the physical examination is important in conjunction with imaging studies, and not separately, in order to determine the definitive treatment of the pathology, and prevent complications.

Case presentation: 74-year-old male from the city of Córdoba, history of hypertension, dyslipidemia, left lower limb DVT treated with oral anticoagulant, total left hip replacement in 2012. Consultation for tumor mass in the left inguinal region in November 2020, with soft tissue ultrasound study which reports left inguinal hernia. Abdominopelvic CT and MRI requested. Since then, a multidisciplinary approach has been carried out. The CT report indicates a tumor in the iliac psoas region, MRI: presence of a pseudotumoral lesion in the inguinal region with an ovoid morphology and clear edges, with projection in front of the femoral prosthetic component, which extends towards the pelvic cavity through the femoral arch, in topography of the iliac psoas bursa, conditioning displacement of the inguinofemoral vascular bundle, with a size of 98 x 65 mm. in diameter, interpreting it as a possible reactive granulomatous lesion (metallosis). Tumor biopsy was performed, the pathology study was free of malignant findings. AngioCT was performed to assess vascular compromise. The tumor did not compromise the iliac vessels, but it did compress the vein and displaced them. Tumor resection is performed, reporting that the 12x7x5.5cm nodular formation corresponds to an organized hematoma, with fibrous tissue in the periphery, numerous histiocytes with multivacuolated cytoplasm, and hemosiderophages with foreign body-type multinucleated giant cells.

This rare tumor should be considered as a differential diagnosis in these patients with this history.